SENIORS CAN HELP IN FIGHT ON MEDICARE FRAUD

When older Americans get concerned by the health coverage provided by Medicare, they usually worry about what's covered and whether or not the national program is going to run out of funds.

Many Medicare participants would like to see prescription benefits added to Medicare coverage, as would President Clinton. And the boom economy has eased a lot of worries about the demise of the Medicare program in a few years.

But there is still one good reason to worry: fraud.

The latest audit of Medicare reimbursements, covering all of 1999, shows that some health-care providers are soaking the program to the tune of $13.5 billion. That's up a bit from 1998, but far below fraudulent claims totaling $20 billion a year for several years.

The Health Care Financing Administration, which runs the Medicare program, has been cracking down on fraud since 1993. Most of the problems, officials say, are due to inadequate documentation. Too many claims are being paid when there isn't sufficient proof that services were actually provided.

Anyone who has looked at a detailed hospital bill, pharmacy bill or Medicare statement knows how complex medical charges can be. Most hospitalizations nowadays result in an avalanche of bills, many from providers a patient might not even know were involved in the treatment process.

Once upon a time, hospital patients were handed a detailed bill before they walked out the door. But now hospitals only bill for charges incurred by the hospital. Primary-care doctors bill separately. Radiologists bill separately. And on and on. By the time a person who has been hospitalized -- or the patient's relatives -- get a bill, it's all too difficult to figure out who is charging for what. Too many recipients of health care simply trust the bills are accurate and pay them.

But the first line of defense against fraud -- whether it's Medicare, private insurance or out of your own pocket -- is vigilance. Patients who carefully keep track of what health-care providers are charging and asking questions about charges they don't understand are doing themselves a big favor. They are also helping to keep down premiums for private insurance. And they are helping to keep a lid on fraud.

The TRIAD/SALT Council, a coalition of senior-citizen groups and law enforcement in our area, is sponsoring a free seminar on "Medicare Fraud: Who Pays? You Pay." It begins at 8 a.m. next Monday in the fellowship hall of Grace United Methodist Church, Broadway and Caruthers. The seminar lasts until 12:30 p.m. when a complimentary lunch will be served.

Anyone interested in learning more about understanding medical bills and in squelching fraudulent charges is encouraged to attend this seminar.